by Daniel Macdonald (Sports Physiotherapist) Pain on the outside of the hip is one of the most common complaints we see in clinic — particularly in women over 40.
It’s often diagnosed as
Hip bursitis
But in many cases, the real issue is
Gluteal tendinopathy
Understanding the difference is key — because the treatment approach is completely different.
What is Hip Bursitis
A bursa is a small fluid-filled sac that reduces friction between tissues.
When irritated, it can become inflamed, leading to pain on the outside of the hip.
However, true isolated bursitis is less common than people think.
What is Gluteal Tendinopathy?
Gluteal tendinopathy involves irritation or overload of the gluteal tendons, particularly where they attach to the hip.
This condition is now considered the primary cause of lateral hip pain.
Common Symptoms (Both Conditions)
• Pain on the outside of the hip
• Pain when lying on your side
• Pain with walking, stairs or standing
• Tenderness to touch
Why the Diagnosis Matters
If you treat tendon pain like inflammation only (rest, ice, stretching), you may:
- Feel short-term relief
- But fail to fix the underlying issue
Tendons need gradual loading to heal properly
The Real Cause: Load vs Capacit
Most hip pain develops when:
- The load on the tendon exceeds its capacity
- Often due to weakness, poor control, or sudden increases in activity
What Actually Works
1. Load Management
Reducing aggravating movements temporarily
2. Progressive Strengthening
Targeted glute strengthening exercises
3. Movement Retraining
Improving hip and pelvic control
What to Avoid
• Aggressive stretching of the hip
• Sleeping positions that compress the hip
• Crossing legs frequently
When to Seek Help
- Pain lasting more than 2–3 weeks
- Pain affecting sleep
- Pain limiting walking or exercise
Final Thought
Most “hip bursitis” is actually a tendon problem — and that’s good news.
Because with the right approach, it is very treatable.